Assessment

It is well documented that obesity increases the risk of other conditions such as hypertension, hyperlipidaemia, hospital diabetes, skeletal disorders and respiratory disease. In addition, the elimination of other conditions such as hypothyroidism (which can lead to weight gain) is important. A thorough assessment should therefore include the following:

A random or fasting blood glucose level

A plasma lipid profile including triglyceride, total cholesterol, HDL and LDL cholesterol levels

Serum TSH levels

Measurements of blood pressure

The documentation of any physical effects, such as reduced mobility, joint pain, breathing difficulties (exploring the possibility of sleep apnoea: include questions regarding the quality of sleep and reports of any notable snoring).

The documentation of any psychological effects, such as low self-esteem and depression.

If measuring blood pressure, use a larger cuff size where appropriate. Inaccurate readings will be obtained if the cuff size is too small.

If conducting a physical examination ensure that an appropriately sized gown is available.

In patients with certain co-existing diseases, the assessment may be extended to include a chest X-ray, echocardiogram (ECG) or glucose tolerance test.

Rare causes such as Cushing's syndrome should only be screened for in the presence of other clinical signs.

Cushing's Syndrome

Cushing's syndrome is a hormonal disorder resulting from an excessive production of corticosteroids in the adrenal glands. Symptoms vary but most people will have upper body obesity with muscle wasting evident on the arms and legs. Sufferers may have a characteristic moon shaped face and the skin can be thin with striae visible on the abdomen, thighs, buttocks, arms and breasts. The hormonal changes can affect mood, levels of fatigue, fertility, blood glucose levels and blood pressure. A 24-hour urinary cortisol level is the most specific diagnostic test. Levels higher than 100 micrograms a day for an adult suggest Cushing's Syndrome. A chest X-ray and MRI or CAT scans may be required. Cushing's syndrome has an incidence of less than six new cases per million per year and it is very uncommon for Cushing's syndrome to cause severe obesity. Those suspected of having Cushing's syndrome should be referred to an endocrinologist for further evaluation.